From the time a newborn let’s out that first shrill scream, most parents see to it that their child gets regular medical attention, making frequent visits to the baby’s doctor for well-child checkups in the initial weeks, months and years of life. But as kids grow older, and visits become less regular, many see the doctor less often than recommended.
Recent data from the Centers for Disease Control and Prevention suggest parents are increasingly taking their kids, tweens and teens in for annual well-child checkups. Estimates released in a CDC Morbidity and Mortality Weekly Report in January show that from 2008 to 2014, the proportion of kids 10 to 17 years old who reportedly did not receive a well-child checkup during the past 12 months dropped from nearly 1 in 3 — or 31 percent — to slightly more than 1 in 5 kids — or 21 percent. While down, though, the latest statistics show a significant number of kids still aren’t undergoing regular checkups, including an estimated 20 percent in metropolitan areas and 28 percent in nonmetropolitan or rural areas. Doctors say when parents don’t take children and adolescents in for regular visits they risk not completing recommended vaccines; forgoing crucial discussions that could have health, safety and even life and death implications; glossing over weight or growth related-issues; and possibly missing early warning signs of physical or mental health issues, such as depression, abnormal cholesterol levels or high blood pressure that could affect cardiovascular health in decades to come.
“These aren’t just like quick, ‘How ya doin” visits. These are really important checkups and assessments,” says Dr. Cora Breuner, who heads the American Academy of Pediatric’s Committee on Adolescence. Rather than waiting until a child gets sick to see the doctor, she says, parents should view well-child visits as a way to ensure kids stay healthy.
Pediatricians say often parents bring kids in for a meningitis vaccine and a vaccine booster for tetanus and whooping cough that are required for school, but are less likely to see the doctor when they don’t have vaccines scheduled. “It’s a little different if a child has a chronic illness like asthma or ADHD, where we’re giving them ongoing medications,” says Dr. Kristin Hannibal, clinical director of the primary care center at Children’s Hospital of Pittsburgh, and associate professor of pediatrics at the University of Pittsburgh School of Medicine. “But when children are healthy they tend to sometimes fall behind on their well-child visits. Especially during the teenage years, we struggle greatly trying to get kids to come in, and it’s actually evident from the HPV vaccine series.”
The CDC and AAP recommends routine vaccination of boys and girls at 11 to 12 years for the human papillomaviruses, or HPV, the common sexually transmitted virus that can cause cancers of the mouth and throat as the cervix and genital organs. It’s most effective if administered before a person becomes sexually active and is known to help prevent cancers and genital warts that are caused by HPV, though it remains controversial with some parents because of the virus’ and subsequent vaccine’s association with sex. However, in Hannibal’s experience, there’s another reason many kids don’t get the full three-part HPV vaccine series: “Many times we’re very good about getting that first dose in when they come in for other vaccines, but it’s the follow-up vaccines that they [miss],” she says. “We often have a lot of incomplete vaccine series, because the kids just don’t come back.”
Many patients Hannibal sees are on Medicaid and, with limited income, face transportation difficulties, like needing to ride a bus with multiple children; that makes some parents think twice about going to the doctor when their child is well. But while access to care and financial constraints can affect how often parents take kids to see the doctor, experts say across-the-board a significant proportion of those ages 10 to 17 don’t get in for recommended annual checkups. “Unfortunately, those are missed opportunities,” says Dr. Ray Tsai, president and chief medical officer of Children’s Health Pediatric Group, which has offices throughout the Dallas-Fort Worth area. Children in junior high and high school are not only going through rapid physical growth, but also maturing emotionally and experiencing significant hormonal changes, Tsai says. “So those physical exams during their teenage years are incredibly important to measuring growth and development, both in physical and emotional maturity, but also in screening for behavioral health issues that are increasingly prevalent.”
Primary care doctors are often the first to diagnose and treat mental health conditions, and can refer patients to mental health professionals for additional treatment. “There’s evidence that [for] behavioral health issues, such as depression and even schizophrenia — treating them early can actually reduce the severity … later,” Tsai says. Treatment can have an immediate impact as well, and even prevent suicide, the No. 2 cause of death in adolescents, notes Breuner, a pediatrician at Seattle Children’s Hospital and professor of pediatrics at the University of Washington School of Medicine. “We know that in the primary care provider’s office, just a two-question screen for depression can also save thousands of lives in kids every year who are fighting depression, in terms of getting them into the right place [for treatment].”
Similarly, she views discussions about safety as a preventive, lifesaving health measure, where motor vehicle accidents rank as the No. 1 cause of death. “Making sure kids are wearing seat belts, making sure kids are not drinking and driving, making sure kids are not texting and driving — all of these things, at some level it doesn’t feel like it equates to a vaccine, per se, but it is,” Breuner says. Since homicide is the No. 3 cause of death in adolescents — and because of the danger of accidental shootings, when kids have access to firearms — she also discusses gun safety and storage.
As kids go through changes post-puberty, visits also offer them the opportunity to speak with their doctor one-on-one about concerns they may have, and, experts say, to begin to take the lead on matters affecting their health, while physicians continue to partner with parents as well. Breuner advises parents who may be inclined to breeze in for a quick physical that’s required to participate in sports to stick around, and be sure their child gets a full comprehensive exam, each time they’re in the office. That ranges from making sure they’re up on all immunizations to checking on proper weight gain (including checking for signs of an eating disorder, if they’re losing or gaining in concern ways) and addressing kids concerns.
Finally, mounting research finds that detecting and addressing issues in children, like high “bad” LDL cholesterol — including a genetic condition called familial hypercholesterolemia — through lifestyle changes and medication if needed, can significantly reduce a person’s risk of death, such as from heart attack and stroke, as an adult. To start, the National Heart, Lung, and Blood Institute guidelines recommend all children undergo a cholesterol screening between ages 9 and 11. “If you can intervene earlier … you can prevent those deaths that quote unquote ‘run in the family’ from heart disease,” Tsai says. Such early intervention, he notes, can set a new healthier curve for the rest of a kid’s life.
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Why Older Kids Need Well-Child Checkups, Too originally appeared on usnews.com
